Risk of osteonecrosis in patients taking bisphosphonates for prevention of osteoporosis: a systematic review and meta-analysis

Abstract

The available evidence suggests that use of BPs in cancer patients is associated with a substantial risk for ONJ. Patients receiving IV BP are at highest risk.

Osteoporosis: recent advances in diagnosis and management

“…9 In the UK there is a move towards adopting 20 per cent risk for any osteoporotic fracture and 5 per cent for hip fracture. Fixed treatment thresholds for people in the UK are attractive as they are easy to use and allow clear division into low risk (less than 10 per cent for any fracture and 3 per cent for hip fracture), intermediate risk (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) per cent for any fracture and 3-5 per cent for hip fracture) and high risk (>20 per cent for any and >5 per cent for hip fracture). In the absence of national guidance, the decision as to which treatment threshold to use needs to be agreed locally.…”

“…ONJ is defined as exposed and necrotic bone in the maxillofacial region that does not heal within eight weeks (see Figure 2). It is a rare adverse event (less than 1 in 1000 18 ) that has been reported with bisphosphonates (particularly intravenous) and denosumab, but the risk of ONJ is far outweighed by the potential benefit of fracture risk reduction. It is thought that the risk of ONJ can be reduced by patients undergoing any necessary dental treatment before starting these medications.…”

Updates on mechanism of action and clinical efficacy of risedronate in osteoporosis

“…Even if some authors suggested that oral bisphosphonates can cause ONJ in patients with osteoporosis, data are very conflicting to date. In fact, recent meta-analysis indicate BFs use for osteoporosis is associated to ONJ incidence, lower than 1 on 100,000 patients every year of exposure (44). Another adverse event that has been linked to extended treatment with bisphosphonates is the occurrence of atypical diaphyseal subtrochanteric fractures.…”

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

“…Four reviews pooled data across studies in a meta-analysis. 120,[122][123][124] Evidence from these reviews indicates that rates of GI toxicity are similar following treatment with alendronic acid, risedronic acid, oral ibandronic acid and placebo. However, observational data suggest a high level of reporting of a number of conditions in the first month of therapy with alendronic acid or risedronic acid, particularly those affecting the upper GI tract.…”

“…Recently, Lee et al 120 undertook a meta-analysis of 12 cohort and case-control studies evaluating oral and i.v.-administered bishphosphonates. An inclusion criterion was that the studies were carried out in non-cancer patients.…”